Located in California, the client’s practice is focused on treating a broad spectrum of psychiatry and neurology-related conditions, such as depression, anxiety, bipolar disorder, schizophrenia, epilepsy, and Parkinson’s disease. The practice works with twenty insurance providers, including Medi-Cal managed healthcare (administered by local counties) and various commercial insurance companies.
Despite its expertise in mental and behavioral health services, the practice faced significant challenges in the claims submission process, resulting in high denial rates and considerable revenue loss
The client’s medical billing team was facing challenges in managing the diverse claims submission requirements of twenty different insurance payers. Delayed and unpaid claims were negatively impacting cash flow and the overall financial health of the practice, making efficient claims processing and follow-up essential.
They needed:
To address these needs, we provided denial management services, along with claims submission management and RCM audit support.
The healthcare provider faced several denial management challenges, including:
Additionally, the practice had to navigate the complex submission requirements and policies of over 20 insurance providers, including Medi-Cal managed care programs. An audit of the client’s revenue cycle management revealed that most claims were denied due to missing or incorrect information, or non-compliance with new policies, particularly with Medi-Cal managed healthcare programs.
Dedicated Team Setup
We assembled a specialized team of 15 members to tackle the client’s challenges. The team included:
